Provider Demographics
NPI:1326879446
Name:BRUNSVOLD, CALLIE FORNEY (RDH)
Entity type:Individual
Prefix:
First Name:CALLIE
Middle Name:FORNEY
Last Name:BRUNSVOLD
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3760 MEALER RD
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37034-2307
Mailing Address - Country:US
Mailing Address - Phone:615-983-0133
Mailing Address - Fax:
Practice Address - Street 1:3991 CAROTHERS PKWY
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-5933
Practice Address - Country:US
Practice Address - Phone:615-628-7728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-10
Last Update Date:2024-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11228124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist